This most recent, alarming case, outlined in a major newspaper article, was of a young woman who sought medical care and an accurate diagnosis from 10 physicians over three years. All of them attributed her symptoms to various non-life-threatening disorders that didn’t require a sufficient degree of care.

Most physicians told her it was stress and she should modify her lifestyle. One physician suggested she needed to lose weight, which was the cause of her many symptoms.

Finally, in excruciating pain, she went to a hospital emergency room. The diagnosis and treatment? Ovarian cancer and the removal of a tumor weighing over four lbs. was extracted from her stomach. How did they miss this, and why was she told it was stress, weight, and lifestyle? Obviously, she is not alone in this failure to listen and diagnose a deadly illness.

Aren’t there tests for ovarian cancer? I recall over 20 years ago being asked to write an article for an oncologist at a prestigious hospital (it would be published under his name) for CA-125. I have no idea if he had it published. But the problem is not limited to cancer or ovarian cancer, specifically.

We know that heart attacks in women are a major concern in healthcare. The reason? Women’s symptoms aren’t classic as they are in men. When women reveal their physical distress, it may be viewed as the oh, so biased diagnosis of anxiety.

It’s the same old song; gender bias in medicine. And it has been receiving more attention as physicians publish opinion articles. The “good little girl syndrome” is at work once again. In medicine, it’s exhibited when women feel intimidated in a power situation where they aren’t on equal footing.

The topic isn’t how to deal with medical anxiety but how to appropriately handle medical situations that may entail life and death questions. No longer should we be viewing medical personnel, as Alec Baldwin said in the film, “Malice.”

When questioned in the film about his role as a surgeon in the operating room, Baldwin says, “I am God” in the operating room. Currently, the god aspect of medicine has been addressed and, hopefully, changing with new medical personnel. Bringing attention to this dangerous self-concept should also emphasize attention to diagnosis and inherent bias.

A reversal of communication problems also can be seen when parents with sick children are believed when they should be viewed askance. In some instances, these individuals depend on deceiving medical personnel in diagnosis. When destructive, possibly psychopathic caregivers are in charge, the result may be to circumvent child advocacy, as in the case of Munchausen’s Syndrome by Proxy (MSP).

A recent case made national headlines when a young seven-year-old girl was viewed as suffering from a mysterious, untreatable, and deadly ailment. One of the things she wished for came from the Make a Wish Foundation that granted it.

The little girl’s tragic journey began when she was two-year-old, and her mother took her for treatment. Here, the mother was believed each time, and repeated surgeries were performed. Ultimately, the mother signed her daughter into hospice and requested a DNR form.

Hundreds of thousands of dollars in donations from various charities and Medicare for medical treatments were provided to the mother. According to the symptoms of MSP, the goal is for the guardian/parent to receive attention and be lauded for their continued care for the child. I wrote on MSP in an article for Postgraduate Medicine. The article resulted in my decade of TV appearances.

Although usually limited to children, MSP is also found in men seeking medical care for their wives. The research, however, thus far concentrates on women since they are the main care providers for children and children appear to be the prevalent victims.

Often, the caregiver has a medical background of some type or is knowledgeable about medical procedures and diagnoses. Rather than seek care at one hospital, they may circulate to several, knowing there would be no medical records shared by all of them. The loophole creates an opportunity for deceit and death.

Fortunately, someone blew the whistle as this mother proceeded to take another daughter for “treatment” of a curious ailment. An investigation by a county sheriff’s office led to the mother’s arrest after the death of the first child. Caught, the mother entered a guilty plea resulting in her being sentenced to 16 years in jail. The child’s step-father sued one of the hospitals that provided care for the girl and did receive an award.

Licensing authorities for many professions, including medicine, mental health, barbers, hairdressers, and others, require continuing education to aid in reporting abuse of adults, children, and the elderly and making accurate diagnoses. Training to address bias is also mandatory, but not everywhere.

If I were to suggest a film on caregiving and legal abuse, I’d recommend “I Care a Lot.” It is not a comedy.

The post “Deaf” Physicians’ Failure to Listen to Seriously Ill Patients appeared first on Medika Life.

Evert shared more details about her journey in the cancer realm, co-authoring an article with sports journalist Chris McKendry. It is a story of early detection, surgery, and chemotherapy for cancer that began in the tennis great’s fallopian tube.

Today, we look at Chris Evert’s experience before turning to some takeaway messages about cancers of women’s ovaries and fallopian tubes.

Here is how it began, according to a text from Evert to her friend McKendry:

“I can’t talk right now, but the pathology report came back today and revealed I have a malignant tumor in my fallopian tube; going in for more surgery next week then chemo … f — — me…”

Fortunately, the cancer is in an early stage. Evert discovered cancer while having a preventative removal of her uterus (hysterectomy). There appears to be no cancer elsewhere in her body. Now, Evert is receiving chemotherapy.

Ovarian cancer numbers, signs, and symptoms

We typically include cancer in the fallopian tubes under the general category of ovarian cancer. The fallopian tubes extend from the right and left ovaries to connect to the uterus.

There are an estimated 21,410 cases of ovarian cancer in the United States annually, according to the US Surveillance, Epidemiology, and End Results (SEER) database. Ovarian cancer represents 1.1 percent of all cancers and corresponds to about one in 10,000 women.

The Mayo Clinic (USA) explains that when ovarian cancer first develops, it is often not associated with apparent symptoms. When symptoms occur, they are often attributed to other, more common conditions. Here are some of the symptoms that may occur:

• Weight loss
• Abdominal swelling or bloating
• Quickly feeling full when eating
• Pelvic discomfort
• Tiredness
• Back pain
• Bowel changes (for example, constipation)
• A need to urinate frequently

Please see a health care professional if you have any symptoms of concern.

Ovarian cancer risk factors

It is not clear what causes cancer, but we know of risk factors that increase the probability of getting the disease. Ovarian cancer begins when cells in the ovaries or fallopian tubes develop genetic (DNA) changes or mutations. The cellular DNA instructs the cell what to do.

Mutations can lead the genes to tell the cells to grow and multiply quickly. The result? A mass or tumor of cancer cells. Unfortunately, the cancer cells can break off (metastasize) to spread to other parts of the body.

The American Cancer Society offers these risk factors for ovarian cancer:

• Being overweight or obese
• Having no full-term pregnancies before age 35
• Taking menopausal hormone therapy (estrogen alone or in combination with progesterone)
• A family history of breast, ovarian, or colorectal cancer
• A personal history of breast cancer
• Fertility treatment (in vitro fertilization (IVF) appears to increase a type of ovarian cancer known as “borderline” or “low malignant potential.”
• Smoking increases the risk of mucinous ovarian cancer

Ovarian cancer — Inherited genetics

The next category applies to our tennis star — her sister died of ovarian cancer in 202 at age 62. The two sisters raced through the airport to make their flight to the WTA Finals in Singapore in October 2017 when Chrissie realized that her sister Jeanne was out of breath and couldn’t keep up.

• A family cancer syndrome — Up to 25 percent of ovarian cancers are a part of family cancer syndromes secondary to inherited changes (mutations) in specific genes.

In the case of the Evert sisters, both had an inherited mutation in BRCA1 (breast cancer gene #1).

Ovarian cancer can run in families; the more relatives with the disease, the higher the risk. And remember — this increased risk can come from your mother or your father’s side of the family.

Mutations in the BRCA gene are responsible for most inherited ovarian cancers. BRCA mutations are ten times more common in those who are Ashkenazi Jewish, compared with the general population in the United States.

Listen to this frightening statistic: The lifetime chances of getting ovarian cancer for women with a BRCA1 mutation is 35 to 70 percent. For those with a BRCA2 mutation, the risk by age 70 is between 10 and 30 percent.

Relevant to Chris Evert, these mutations also increase the risk of fallopian tube cancer. In contrast, the lifetime ovarian cancer risk in the general population is less than two percent.

Ovarian cancer prognosis

What are the odds of survival for our beloved tennis star? The US SEER database informs us that the overall survival chances are about 29 percent for ovarian cancer.

Chris Evert joins the 16 percent of those with ovarian cancer who catch it early (having risk-reducing surgery as a “preventative” maneuver). When caught in a localized stage, the odds of surviving ovarian cancer are 93 percent.

Early detection matters — for those with regional disease, the survival rates drop to 75 percent, and if the disease spreads to distant sites, it is 30 percent, looking at the 2011 through 2017 time frame. Fortunately, long-term survival rates have been improving significantly over time.

Ovarian cancer — Lowering your risk

The Mayo Clinic reminds us that there is no sure way to prevent ovary cancer. However, women may reduce their risk by taking birth control pills (oral contraceptives). These medicines have other risks, so it is crucial to dialog with well-informed healthcare professionals.

If you have a family history of breast or ovarian cancers, please discuss this with a health care team member. You may be referred to a genetics counselor. If you have a concerning gene mutation that increases your risk of ovarian cancer, many women consider surgery to remove their ovaries and fallopian tubes as a preventative maneuver.

Someday, we may have a better way to catch ovarian cancer early:Detecting Cancer: Dogs, Electronic Noses, and MoreOVARIAN AND PANCREAS CANCERS are challenging to diagnose early. In this context, I am delighted to bring you good news…medium.com

Left ovarian cancer, Stage IC3, high-grade serous type

As is the case for many women, Chrissie Evert had no noticeable symptoms. This lack of symptoms is not surprising, as early-stage ovarian cancer is challenging to detect. Evert also had annual tests for the cancer antigen 125 protein in her blood, and her imaging (ultrasounds and MRIs) was unrevealing. In this context, listen to Evert:

“I am so lucky. ” Evert speaks with the conviction of someone who has witnessed the unlucky. Continuing, she offers this advice: “Be your own advocate. Know your family’s history. Have total awareness of your body, follow your gut and be aware of changes. Don’t try to be a crusader and think this will pass.”

Ovarian cancer is uncommon. If you have a family history of breast or ovarian cancer, get genetic counseling and testing if indicated). Thank you for joining me today. One more thing: Inherited genetics such as the breast cancer gene mutations (BRCA1 and BRCA2) can affect men, too.

Today, one week ago, I saw this disturbing observation published: “Despite unequivocal recommendations for universal genetic testing in ovarian cancer, only 34 percent of patients [in the USA] with commercial insurance were tested between 2008 and 2018 — clear evidence it remains underused.”

The post Tennis Legend Has Ovarian Cancer appeared first on Medika Life.

We ran a simple and easy test to see if she carried the genetic mutations associated with an increased risk of breast cancer. Her test results indicated she was a carrier. Now she faced some difficult decisions. Should she undergo a prophylactic mastectomy or take a chance and have one more child. 

Many women know breast cancer runs in their family. They live in fear, wondering if they will also develop cancer. Some have heard about testing for the breast cancer genes, but are unsure how to pursue this option. 

Men and women with a family history of cancer may qualify for genetic testing to help make life-saving decisions. 

What are the breast cancer genes?

Genetic mutations in BRCA 1 and BRCA 2 are linked to an increased risk of breast cancer. Although the names sound similar, these two genes are not related at all. BRCA1, first identified in 1990, is on chromosome 17. BRCA2, identified in 1994, is located on chromosome 13.

Other gene mutations are linked to various cancers, but BRCA mutations are the most common and most well-known. 

Mutations in these two genes not only increase the risk of breast cancer but other cancers as well. BRACA 1 and 2 mutations increase the risk of ovarian and pancreatic cancer. 

A BRCA1 mutation can increase the risk of cervical, uterine, and colon cancer, while mutations on BRCA2 can increase stomach, gallbladder, bile duct cancer, and melanoma.

Mutations in the BRCA 1 and 2 genes change the function of the cells containing them. These genes are known as tumor suppressors. When functioning normally, their job is to create proteins to suppress cancer and help maintain cell growth.

When deleterious mutations are present, cells have the potential for unchecked growth leading to an increased risk of cancer.

Do I have the BRCA 1 and 2 genes?

Everyone has two copies of these genes. All of our cells contain genes holding our body’s genetic code. We all have BRCA 1 and 2 genes. The increased risk of cancer comes when we have a mutation in the gene. 

Gene mutations alter the genetic code inside of cells. Certain mutations change the function of cells. 

We inherit our genes from our parents. One copy comes from our mother and the other from our father. When we inherit one gene mutation from a parent, every cell in the body will possess one mutated copy of the gene and one normal copy.

People with no abnormal BRCA mutations have the lowest risk. One copy of a mutated gene increases cancer risk, but the other gene promotes tumor suppression. 

When two mutated copies are present, the lifetime risk of cancer increases to a dangerous degree. 

Because harmful mutations may be inherited from either our mother or the father, our complete family history is the best indicator of a potential mutation. Physicians will evaluate the maternal and paternal family cancer history to determine the risk level and the need for testing.

Doctors evaluate for specific risk factors:

• Breast cancer diagnosed before age 50 years
• Cancer in both breasts in the same woman
• Both breast and ovarian cancers in either the same woman or the same family
• Multiple breast cancers in the family
• Two or more primary types of BRCA1– or BRCA2-related cancers in one family member
• Cases of male breast cancer
• Ashkenazi Jewish ethnicity

Certain ethnic groups are also at a higher risk of having these mutations, including those with Ashkenazi Jewish backgrounds. Ashkenazi Jewish people have as high as a 1 in 40 chance of possessing a harmful BRCA1 or BRCA2 mutation.

How much does my cancer risk increase if I have a mutation?

Recent breast cancer statistics suggest that 1 in 8 women will develop be breast cancer in their lifetime. Approximately 60 percent of women who have inherited these harmful gene mutations will develop breast cancer. By age 70, the risk of breast cancer for mutation carriers is:

• 55–65 percent for BRCA1 carriers
• 45–55 percent for BRCA2 carriers

IIt’s essential to remember the following:

• Not all breast cancer is due to these genetic mutations. 
• Scientists’ best estimates suggest that only 5 to 10 percent of breast cancers are due to the mutations of BRCA1 and BRCA2.
• Not every woman with a harmful mutation gets cancer. 
• Not all women with the mutation will develop breast cancer, but more than half of them will, and many at an earlier age than the average diagnosis.

Testing For BRCA1 and 2 mutations

Genetic testing for these mutations is available for those who qualify. Thanks to the Affordable Care Act, insurance coverage is guaranteed if an individual meets testing criteria. But only about 2 percent of the general population will meet the strict testing guidelines.

Blood or saliva is collected for genetic testing in a doctor’s office to be sent to a testing company. It can take several weeks to receive the results. 

Genetic counseling both before and after the test is highly recommended. Learning about the presence of a cancer mutation can be emotionally and psychologically challenging. It is crucial to speak with an expert who can guide patients through the implications and possible options..

What are my options if I am a BRCA mutation carrier?

Women who do test positive have options. It is important to speak with a specialist well-versed in genetic counseling. The management is highly dependent on the patient’s age and family planning status. 

Patients will start an individualized cancer prevention plan. This often includes a twice-yearly clinical breast exam combined with Breast MRI and mammograms alternating every six months. Monthly breast self-examination may be encouraged.

Some may qualify for annual CA-125 blood tests combined with transvaginal ultrasound for ovarian cancer prevention. Young patients may be started on oral contraceptives to reduce the risk of ovarian cancer. 

BRCA 2 carriers will be referred for annual skin evaluation to monitor for melanoma. 

Some women may choose to freeze their eggs to preserve their fertility later in life. Egg preservation is an available option for carriers not ready to have a baby now, but who want to keep their options open.

Some women may choose risk-reduction surgery. The breasts and surrounding tissue can be removed to reduce the risk of breast cancer. This procedure is called a prophylactic bilateral mastectomy. Bilateral prophylactic mastectomy reduces breast cancer risk by 95 percent in women with a BRCA 1 mutation and 90% in a BRCA2 mutation carrier.

Ovarian cancer risk-reduction surgery is called a prophylactic bilateral salpingo-oophorectomy. The fallopian tubes and ovaries are surgically removed. Ovarian cancer risk decreases by 90%, and breast cancer risk reduces by 50% after removing the fallopian tubes and ovaries.

Removing the ovaries causes surgical menopause. Hot flashes and night sweats are two of the most common and frustrating menopausal symptoms.

Why is genetic testing important?

People with a strong family history of cancer often worry about getting cancer. Parents worry they may have passed on harmful genes to their children. 

Getting tested is simple and easy for those who meet testing criteria. When we find a negative test, indicating the mutation is not present, a weight of worry comes off the patient’s shoulders. 

When we find a positive test indicating a harmful mutation is present, we can individualize a cancer prevention plan to encourage early detection and prevention. Genetic testing can be a key step to a long and healthy life.

The post Here’s What You Need to Know About BRCA 1 and 2: The Breast Cancer Genes appeared first on Medika Life.